Veterinary Clinic Practicum Registration

Name of clinic:*

Physical address*please include address, municipality, province and postal code

Mailing address different than physical address?*

Yes

Mailing addressOnly required if different than the physical address

Clinic phone number*

Clinic websiteIf your clinic has a website, please fill in this space

Does your clinic use social media?*

Yes

Please list social media Include your clinic handle or page name

What type of practice is your clinic*

Small animal

Large animal

Mixed animal

Emergency

Other

If other, please describe your clinic

Please tell us more about your clinic and types of experiences a practicum student might encounter*

For the following questions, please indicate the number of each type of staff at your clinic.

Veterinarians*

RVTs*

VMAs*

Receptionists*

What type of students would you be willing to take on for their practicum?*

Veterinary Technology (VT)

Veterinary Medical Assistant (VMA)

Either

Practicums are in specific time periods. Please choose all that apply for your clinic.*

VT - March to May for 6 weeks

VT - July to August for 6 weeks

VMA - April to May for 4 weeks

Are you able to take more than one student at the same time?*

Yes

Are you able to offer accommodation for a practicum student?*

Yes

Describe other benefits or advantages from choosing your clinic?*Please let our students know what you offer them if they choose your clinic for a practicum

Clinic contact name:*

Clinic contact email:*

Clinic contact phone number:If the contact's number has an extension from the main number or has a separate number, please list it here.